Thoracoscopic treatment of atrial fibrillation on the beating heart

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Recently, surgical treatment of arrhythmia has been widespread. Especially, the surgical treatment of the atrial fibrillation : MAZE procedure has been noticed and has been done by many cardiac surgeon. This procedure can cure the atrial fibrillation by means of cutting and sewing both atrium to recover sinoatrial conduction. However, there are several drawbacks e.g. complicated cutting line, prolongation of the aortic crosclamp time, bleeding. Instead of cut and sew technique, other ablation devices have been developed to solve these problems, there is no device which solve all of these problems. We focused on cryoablation and infrared coagulation systems.Epicardial cryoablation technique (LAVIE) was applied to seven patients. All patient except one has recovered sinus rhythm several weeks after the procedure spontaneously. These are the first cases in the world and presented in The Annals of Thoracic Surgery in 2004. The efficacy of the infrared coagulator also demonstrated in the animal experience using canine and the results will be published in The Annals of Thoracic Surgery this year.The first clinical application of infrared coagulator has been done in 2005, however it failed because of the carbonization of the atrial tissue. We noticed that not only the ablation duration but also energy output is important to control the depth of coagulation, and modified the coagulator to be an energy output controllable one.These results were presented at the 20^<th> Meeting of Japanese pacing and electrophysiological Society in May 2005.The latest model of infrared coagulator is ready to use clinically.